Surgery Decision-Making for Ovarian Cancer

Open Surgery

One factor that goes into the decision-making is how likely it is that the mass in a woman's pelvis is actually ovarian cancer. "A common presentation for ovarian cancer is a woman, maybe in her early sixties, who has findings of a pelvic or ovarian mass on imaging, and an elevated CA 125 tumor marker [from a blood test]," says Dr. Gray, who explains that in a case like this, doctors would see an increased risk and be suspicious that they're dealing with ovarian cancer. For that woman, a traditional open surgery, with a longer abdominal incision, may recommended.

This procedure is called debulking surgery, and doctors remove the uterus, ovaries, fallopian tubes, and a structure called the omentum which is a fatty apron that covers many abdominal organs and is a common spot for cancer cells to spread to. Sometimes lymph nodes are removed for testing, "and about 30 percent of the time we're going to do bowel surgery at the same time because the cancer can glom onto that," says Dr. Gray. The goal of this surgery is to remove all visible disease so that the chemotherapy that usually follows will be more successful.

Minimally-Invasive Surgery

Since ovarian cancer is far more common in women age 50 and older, when a younger woman presents with a pelvic mass or abnormal finding, the chance of it being malignant is much lower. Also, younger womenthose still in their childbearing yearsmay want to preserve their fertility if possible, and that will also influence the type of surgery that can be performed. Some women may be able to deal with their cancer with a minimally-invasive approach (which may or may not be done with robotic help), others may still require open surgery but be able to take advantage of a fertility-sparing technique.

Minimally-invasive surgery may be "straight stick"meaning that doctors insert a lighted tube, called a laparoscope, and other instruments into small incisions in the abdomen, and are able to remove tumor and tissue through the small openings. Sometimes the laparoscopic procedure is done robotically, and instead of manipulating the instruments directly, surgeons control robotic tools that are capable of very precise work.

Women who may be good candidates for minimally-invasive surgery include:

• Women whose pelvic mass has not been definitively diagnosed yet. This is called a staging procedure, to take tissue samples to check for malignancy, and if the diagnosis is cancer to see if or how far it has spread.
• Women with smaller tumors or early stage disease that can be effectively handled with a smaller procedure.
• Women who are considered frail and might not be able to tolerate a bigger surgery.

For any woman with diagnosed or suspected ovarian cancer,  doctors have to decidealong with their patientswhich of the many options available will be the best to treat the patient's cancer, preserve fertility if that's wanted, and not be too overwhelming for women who are frail or dealing with other medical conditions.

Women might feel that they want the larger procedure so that every bit of cancer possible can be removed. Or they might think a minimally-invasive procedure is better because they will have a smaller surgery with a shorter recovery time. But there are many, many factors that go into deciding which surgery is best for each woman. And only talking to your doctor and getting educated about the options can help you make the choice that's best for you.

 

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